Community focus

New data suggests that marketers must shift their attention from individual influencers to complex decision-making units

For many years, Key Opinion Leadership Management (KOLM) has been the dominant paradigm associated with new product penetration. Key Opinion Leaders guard the gates to the market, the received wisdom goes, and so companies fight for their favour and influence. But pause for a moment. Where is the evidence that supports this industry folklore? What's the science behind it?

New thinking about how new prescribing habits permeate a market is shaking the foundations of KOLM and suggesting that there are new strategies, which might be more effective.

The foundation of KOLMKOLM's theoretical roots lie in the late 19th Century work of Gabriel Tarde, but the term Key Opinion Leader was only coined by the sociologists Elihu Katz and Paul Lazarsfeld in the 1950s, based on their research into the 1944 US presidential election. Everett Rogers' 1962 book The Diffusion of Innovation cemented the idea into marketing practice. The basic premise was that the majority of decision makers didn't bother to evaluate choices themselves, but relied on the opinion of a trusted friend who sat at the hub of a network of influence.

Importantly, the academic foundations of this pervasive and much-used model lay in consumer markets, where individuals made choices based on a combination of rational needs and emotional desires. There is much less evidence to support the leader-follower idea in professional or technical markets, such as pharma.

Never-the-less, it is understandable that KOLM took root in pharma from the 1960s onwards. Individual prescribers did make decisions, there have always been leading thinkers and this particular model offered the chance to focus, and economise on, sales and marketing efforts.

Today, more often than not, the decision rests, not with individual influencers, but with complex decision-making units. Decisions to change prescribing practice tend to flow from these units in which doctors, administrators and others work together to develop their ideas.

These modern-day realities call for a re-appraisal of how we model the diffusion of new practice and new products. Thanks to a combination of new concepts in statistics and increasing computing power, this is now becoming possible.

The development of CoPThe new idea on the block is 'communities of practice' (CoP), which first emerged when cognitive anthropologists Jean Lave and Etienne Wenger observed that professionals learn new methods by a process they called 'situated learning'. This refers to learning that takes place in the same context in which it is applied. This type of learning is very different from being taught by a teacher or opinion leader. Later, other researchers observed that CoPs solve problems and push practice forward. Still others discovered that, unless properly managed, barriers between these distinct groups slowed down the adoption of new methods in healthcare settings.

Until now, however, no research has been carried out in a specifically pharmaceutical context and so, from the point of view of the pragmatic pharma marketer, several questions have remained unanswered. Firstly, does the data support the old KOL model or the newer CoP idea? Secondly, what do we know about the structure of CoPs and, thirdly, how might we use this knowledge to improve marketing effectiveness?

Answering these questions has been made possible using a unique database of physician data that captures the behaviour, relationships and activity of thousands of prescribers across Europe. Our research analysed an oncology subset of the data using advanced techniques that are based on social network theory. Critically, this methodology focuses, not on the individuals, but on the connectivity between them. What popped out of the data was as surprising as it was useful.

The first lesson to emerge was that the traditional idea of KOL hubs doesn't seem to fit the data. Instead of a few hubs influencing many individuals, a picture that was much more in line with the idea of CoPs (figure 1) emerged. This picture showed a network of communities, each of 10–20 prescribers, connected through individuals but relatively isolated from the other communities.

Figure 1: A network of communities of practice

So, the data does support the idea that communities of practice exist and that they are 'islands' connected by narrow causeways between certain individuals. This finding began to suggest that the way these communities behaved and what drove their behaviour would be critically important to making practical use of the theory.

To unravel this, more sophisticated analysis — to compare the behaviours and activities of the different groups — was used. This deeper analysis uncovered quite striking differences between the separate groups, as shown in figure 2, which compares just two of the groups examined.

Figure 2: Behavioural and activity profiles of two typical communities of practice

This work answered most of our basic questions. Firstly, the old fashioned KOL model is due for revision. Something like KOLs might exist, connecting communities, but they aren't quite the handful of dominant figures previously thought.

Secondly, smallish CoPs do seem to be the dominant structure and are highly likely to drive prescribing behaviour. These communities, however, are not all alike and differ in what they do and how they think. A wealth of further detail lies beneath these initial conclusions.

Implications for practiceWhat this means in practice could be very important, with CoP management offering marketers who seize the idea first the chance to leap ahead of traditional KOLM.

Four implications of this new thinking are obvious. Firstly, fewer resources might be allocated to those physicians currently perceived as KOLs, with those resources being redirected to important CoPs.

Secondly, the goal of marketing activity might shift away from KOL endorsement towards facilitating the diffusion of new practice between Communities of Practice, because it's likely to be at these barriers that new product acceptance stalls.

Thirdly, this marketing activity might become more tailored to the needs of individual CoPs, reflecting the way in which sources of information, relationships and therapeutic concerns vary between different communities.

Finally, but perhaps most importantly, these changes would imply a significant alteration to what pharmaceutical marketers consider their most important assets. Rather than ranking professional relationships with KOLs as their primary intangible asset, pharmaceutical marketers might well consider their knowledge of CoPs, not only as their most important resource, but also as critical to their competitive advantage.

For the pharma marketer of the future, the database and the analytics may come to outweigh the handshakes and the KOL endorsement in terms of relevance.